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Medical Decision Making Overview

Why is it important for long-term care communities to be attentive to an LGBTQ resident’s durable power of attorney for medical and financial decision-making? 

LGBTQ people often rely on caregivers who are not legally recognized, such as unmarried partners and families of choice. Because of this, these caregivers can be excluded from decision-making on a loved one’s medical care and end-of-life plans, unless there are specific legal arrangements in place.  

Without legal protections, such as durable power of attorney, most states will prioritize opposite-sex spouses and blood relatives for medical and long-term care decisions, including end-of-life care, regardless of the closeness of their relationship with the individual in question. These decisions may supersede closer, non-legal relationships. The problem is pervasive and some experts estimate that up to two thirds of LGBTQ older adults do not have the necessary legal paperwork completed, leaving them unprepared and without needed legal protections in place.

It’s critically important for long-term care communities to cover this topic with residents, encouraging them to secure the necessary protections and then keeping a copy of important documents on file to be referenced in a time of need.

Does your community inform residents of their right to designate a person of their choice, including a domestic partner or friend, as a medical or financial decision-maker?

One of the best ways to ensure that all LGBTQ residents receive information about their right to designate a person of their choice as medical and financial decision-maker is to share this information broadly and with all residents.  Many LGBTQ residents may choose not to share information about their sexual orientation and gender identity/expression, so using a universal communications approach reaches all residents.

Using this approach provides the added benefit of helping to protect heterosexual and cisgender individuals who may likewise prefer to designate someone other than a spouse or blood relative as their medical and financial decision-maker.

For example:

NY Health + Hospital long-term care community provides the following document that utilizes gender neutral/inclusive language 

Does your community keep a copy of medical decision-making and end-of-life documents in the resident's file and refer to them as needed?

Emergencies are just that - emergencies.  In order to be prepared for potentially life-altering events and to be able to contact important decision-makers at the appropriate time, long-term care communities should keep a copy of important legal documents on file, with resident permission.  All staff should be aware of this procedure in the event they need to access these documents in an emergency.